Andrea Blood Tidman, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

042.0015332 Issued in VT

Practice address

52 Timber LN
South Burlington, VT 05403-7204

Phone

(802) 658-2320

NPI assigned

Mar 21, 2018

Last updated

Jul 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Andrea Nicole Blood Former name

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Medicine, PLC

  • Pediatrics Physician
  • South Burlington, VT
  • NPI 1487701140
  NPD (past)
• Richmond Pediatric & Adolescent Medicine

  • Pediatrics Physician
  • Richmond, VT
  • NPI 1326132416
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1770087090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037204",
            "telephone_number": "802-658-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037204",
            "telephone_number": "802-658-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDMAN",
        "first_name": "ANDREA",
        "middle_name": "BLOOD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "042.0015332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "BLOOD",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tamara Rita Thompson, MSW, LCSW
• Kelly Shannon Thorne, PSYD
• Thrivinspired Wellness & Consulting LLC (ThrivInspired Nutrition)
• Through to Thrive LLC (Through to Thrive)
• Emily Thurber, LCMHC, LADC
• Tiffany Renaud, Inc. (Living Well Spinal Care Center)
• Tiffany Renaud, Inc. (Living Well Spinal Care Center)
• Timber Lane Allergy & Asthma Associates, PC
• Timberlane Dental Associates, PLC
• Timberlane Dental Group

• Pediatrics Physician in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Pediatrics Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.